Title

Authors

Publication/Presentation Date

7-26-2013

Abstract

Background

The aging population tends to have an overly positive perception of their state of health.1 However, elders’ perception of their personal fall risk is unclear. In reality, 30% of adults aged 65 years or older fall each year. Falls account for over 80% of injury-related hospital admissions of patients 65 years of age or older.2 These admissions are costly; in 2000, direct medical costs for falls totaled over $19 billion. In 2010 dollars, this equals $28.2 billion.3 The expenses to treat traumatic falls are also staggering to Family Practices; further, prevention campaigns employed by these institutions have not been analyzed for effectiveness. Literature on the subject does not provide answers to patient perceptions about their personal fall risk, their comfort level in discussing their fall history, or a home safety plan with their healthcare provider. Understanding patient perception of personal fall risk is vital when utilizing prevention techniques.

Research Question:

What concordance exists between patients’ perception of their risk for falling and their actual risk?

Secondary Question:

What is patients’ level of openness to intervention and/or communication about their fall risk with healthcare providers?

What effect does alcohol consumption and prescribed medication use have on fall risk?

Study Goals

This survey study’s primary objective is to determine if patients’ perceived fall risk correlates with their personal risk factors. Another aim of this study is to assess patient comfort levels when discussing personal fall history and home safety. Lastly, the Traumatic Falls Survey wants to analyze the impact that medications and alcohol consumption have on fall risk.

Study Hypothesis

Patients’ perceived fall risk does not correlate with their personal risk for falling.

Methods

A survey was developed by the research team that asked demographic questions about age, gender and ethnicity. In addition, a Likert scale was used to assess participant-perceived risk of falling, actual risk of falling, and how comfortable the patient is with home safety evaluation discussions. The survey also asked questions about medications, daily activities and living circumstances.

The survey was distributed by the research scholar at three different family practice locations. Each family practice was located in a different demographic area of the Lehigh Valley. These practices included Riverside Family Practice (rural), Bethlehem Family Medicine (suburban), and Lehigh Valley Family Health Center (urban). Adults participating in this survey were age 50 or older, English- or Spanish- speaking, and were physically and/or mentally able to complete the survey. The research scholar approached each patient, explained the voluntary and anonymous nature of completing the survey, answered any questions, and assisted in survey completion, if needed. Data collection lasted five weeks. The survey data was then added to a secure Excel database by the research scholar. Statistical tests were run on the data.

Results and Conclusions

The primary goal of this study was to determine if patients’ perceived fall risk correlates with the patients’ actual risk of falling. The research team hypothesized that there would be little correlation. A correlation coefficient was calculated and it was discovered there is a strong correlation between patients’ perception of fall risk and patients’ actual fall risk (r=0.823). With this correlation, we fail to reject our null hypothesis. These results were surprising. The high correlation could simply be attributed to a more developed awareness of fall risk within the past few years. Much of the literature that was used to formulate the study’s hypothesis is five to seven years old, so an improvement this substantial would be advantageous to Family Practice settings. Conversely, this correlation could be a result of patients not honestly completing the survey.

This study also aimed to assess comfort levels in patients when speaking about fall risk and home safety assessments. For the entire patient population, 76.3% of patients were comfortable with speaking to their health provider about their fall risk. However, only 46.6% of patients in the study were comfortable with speaking to their doctor about home safety checks. This was anticipated due to patient privacy issues. Patients with a fall history were more likely to talk about both fall risk and home assessments than patients with no fall history. This could be attributed to the fear of falling and not wanting to fall again. Therefore, patients with a fall history are more likely to talk about their risks in order to reduce them.

Data on patients’ weekly alcohol consumption was also collected. It was found that patients with a previous fall history drink six times less than patients with no fall history. These results could be attributed to the well-known effects of alcohol. Patients with a fall history could know that they will be more likely to fall if they drink alcohol. Furthermore, patients with a fall record could have been told to not drink because of the medications they have to take.

Also, data on patient medication was analyzed. On average, patients with a fall history take six prescribed medications per day. This is twice the amount patients without a fall history take. Similarly, patients with a fall history are more likely to be taking both blood thinners and blood pressure medications. These results were expected. It is well known that prescribed medications, blood thinners and blood pressure medications all have side effects that increase the risk of falling.

Future Directions

Compare Family Practice surveys with Emergency Room surveys and 50-Plus Community Event surveys